Dysphagia Lusoria

The vascular abnormality is usually an aberrant right subclavian artery arising from the left side of the aortic arch, a double aortic arch, or a right aortic arch with an aberrant left subclavian artery or left ligamentum arteriosum (1, 2). The dysphagia may develop in childhood or later in life as a result of arteriosclerotic changes in the aberrant vessel.

Definitive diagnosis is usually with CT angiography or MRI (3, 4). Other testing may include barium swallow, which shows extrinsic esophageal compression; echocardiography, which can suggest or show abnormal vasculature; and bronchoscopy, which may be performed when there is concomitant airway involvement and can reveal pulsatile compression typical of a vascular ring.

Most patients with vascular rings diagnosed in adulthood require no treatment, but after careful weighing of risks and benefits, surgical repair is sometimes performed to relieve symptoms or if there is an associated thoracic aortic aneurysm or dissection (3, 4). In children, the decision to treat surgically depends upon esophageal and airway symptomatology, the type of ring, and specific anatomic features such as the size of the diverticulum of Kommerell.